NBRC RRT study guide Questions and
Answers.
Initial vent settings -
\Vt 6-8mL/kg (ideal 6mL/kg) for EVERYTHING except ARDS (4-6mL/kg) and asthmatics
(4mL/kg)
RR 8-12/min
any mode will work but the NBRC likes SIMV
What is bilateral infiltrates and retinulogranular pattern on a CXR indicative of? -
\ARDS; ground glass
PF ratio of ALI and ARDS -
\ALI <300
ARDS <200
ventilating pts with ARDS -
\4-6mL/kg.; high RR to compensate for the reduced Ve caused by using a lower Vt
what is the physiologic function of the inspiratory hold (inflation hold/plateau pressure)?
-
\1. increase mean intrathoracic pressure
2. increase diffusion of gases
3. improve oxygenation
4. decr. the chance of atelectasis
calculates static lung compliance (Vt/PLAT-PEEP)
Downfall of the inspiratory hold/inflation hold -
\potential for cardiovascular side effects and barotrauma
Main thing to monitor in air transport patients? -
\cuff pressures! Cabin pressure is usually only set to 8000ft although you are traveling
at 25k ft; the cuff will incr. in volume as atmospheric pressure decreases (Boyles law)
upon descent the cuff will gradually deflate
neonates dont have cuffs
other names for auto-PEEP -
\dynamic hyperinflation
inadvertent peep
breath stacking
intrinsic peep
occult peep
,weaning fio2 vs. peep -
\wean fio2 first if >60%
How do you correct auto peep? -
\incr. E-time (decr. rate) ***MOST COMMON ANSWER
decr. I-time (incr. flow rate)
use stiffer circuit tubing
use applied peep below the auto peep level
maintain bronchial hygiene
PEEP adverse effects -
\decr. C.O
decr. urine output
increased plateau pressures as well as increasing peak pressures indicates -
\decreasing lung compliance
pathologies of decreasing lung compliance -
\ARDS
atelectasis
pulmonary edema
corrected by adding PEEP or correcting the disease process
Increased peak pressures with no increase in plateau pressures indicates -
\increasing airway resistance (pip-plat=raw)
pathologies assosciated with increased airway resistance -
\bronchospasm, wheezing, ett kinked, secretions
fixed by suctioning, bronchodilators, fixing the kink or vent circuit, etc.
A pt. is on VCV and their peak pressures are consistently in the upper 50's; what do you
do? -
\switch to PCV
determining optimal peep -
\get pao2 >60, spo2 >90%, good lung compliance (cstat), and best cardiac output
(sometimes only BP and CVP are given)
-if pt is hypotensive therefore the pt will have a low C.O; do not add peep >5
what specific alarms should be set on pts in PC-IRV while they're paralyzed? -
\secondary apnea alarm
secondary low pressure alarm
A pt on SIMV is noted for increased WOB; what should you do? -
\add pressure support
, if pt is on psv already and still having issues then increase ps
desired frequency change to bring paco2 to normal range calculation -
\current paco2/desired paco2 x actual frequency
ventilating head trauma pts -
\always use high flow rates to decr. i-time to avoid pos. pressures in airways
use high resp. rates to keep paco2 levels 25-30mmHg
keep ICP's below 15-20mmHg the most*
minimal stimulation for these pts (suction prn)
If the ambu bag fills rapidly and then collapses when ventilation is given what should
you do? -
\check for an absent inlet valve or valve is stuck open
treatment for recently extubated patients with moderate stridor -
\cool aerosol with mask with fio2 around 40-50%
treatment for recently extubated pt with marked stridor -
\anytime the word "marked" is used think emergency
intubate the pt with 100% FiO2
what is the cause of unilateral wheezing -
\obstruction (usually pedi)
rigid bronch to remove object
when do you use an nasopharygeal airway vs an oropharygeal? -
\naso- conscious pt, do not rotate
oro- unconscious pt- insert upside down then rotate
how do you assess for adequate ventilation post intubation? -
\bilat. chest wall mvmt
auscultate LS
etco2 or capnography
abg/pulse ox. and last cxr for tube placement confirmation
pt in acute wheezing while on the vent; abg is drawn-all gases are normal except pao2
is low; what must you do first? -
\give bronchodilator
mallampatti classification scores -
\scores of 3-4 are bad, low visualization of the airway; pt may need video assisted
device
if pt is unconscious, and outside the hospital environment, VAD will not be available to
intubate*
Answers.
Initial vent settings -
\Vt 6-8mL/kg (ideal 6mL/kg) for EVERYTHING except ARDS (4-6mL/kg) and asthmatics
(4mL/kg)
RR 8-12/min
any mode will work but the NBRC likes SIMV
What is bilateral infiltrates and retinulogranular pattern on a CXR indicative of? -
\ARDS; ground glass
PF ratio of ALI and ARDS -
\ALI <300
ARDS <200
ventilating pts with ARDS -
\4-6mL/kg.; high RR to compensate for the reduced Ve caused by using a lower Vt
what is the physiologic function of the inspiratory hold (inflation hold/plateau pressure)?
-
\1. increase mean intrathoracic pressure
2. increase diffusion of gases
3. improve oxygenation
4. decr. the chance of atelectasis
calculates static lung compliance (Vt/PLAT-PEEP)
Downfall of the inspiratory hold/inflation hold -
\potential for cardiovascular side effects and barotrauma
Main thing to monitor in air transport patients? -
\cuff pressures! Cabin pressure is usually only set to 8000ft although you are traveling
at 25k ft; the cuff will incr. in volume as atmospheric pressure decreases (Boyles law)
upon descent the cuff will gradually deflate
neonates dont have cuffs
other names for auto-PEEP -
\dynamic hyperinflation
inadvertent peep
breath stacking
intrinsic peep
occult peep
,weaning fio2 vs. peep -
\wean fio2 first if >60%
How do you correct auto peep? -
\incr. E-time (decr. rate) ***MOST COMMON ANSWER
decr. I-time (incr. flow rate)
use stiffer circuit tubing
use applied peep below the auto peep level
maintain bronchial hygiene
PEEP adverse effects -
\decr. C.O
decr. urine output
increased plateau pressures as well as increasing peak pressures indicates -
\decreasing lung compliance
pathologies of decreasing lung compliance -
\ARDS
atelectasis
pulmonary edema
corrected by adding PEEP or correcting the disease process
Increased peak pressures with no increase in plateau pressures indicates -
\increasing airway resistance (pip-plat=raw)
pathologies assosciated with increased airway resistance -
\bronchospasm, wheezing, ett kinked, secretions
fixed by suctioning, bronchodilators, fixing the kink or vent circuit, etc.
A pt. is on VCV and their peak pressures are consistently in the upper 50's; what do you
do? -
\switch to PCV
determining optimal peep -
\get pao2 >60, spo2 >90%, good lung compliance (cstat), and best cardiac output
(sometimes only BP and CVP are given)
-if pt is hypotensive therefore the pt will have a low C.O; do not add peep >5
what specific alarms should be set on pts in PC-IRV while they're paralyzed? -
\secondary apnea alarm
secondary low pressure alarm
A pt on SIMV is noted for increased WOB; what should you do? -
\add pressure support
, if pt is on psv already and still having issues then increase ps
desired frequency change to bring paco2 to normal range calculation -
\current paco2/desired paco2 x actual frequency
ventilating head trauma pts -
\always use high flow rates to decr. i-time to avoid pos. pressures in airways
use high resp. rates to keep paco2 levels 25-30mmHg
keep ICP's below 15-20mmHg the most*
minimal stimulation for these pts (suction prn)
If the ambu bag fills rapidly and then collapses when ventilation is given what should
you do? -
\check for an absent inlet valve or valve is stuck open
treatment for recently extubated patients with moderate stridor -
\cool aerosol with mask with fio2 around 40-50%
treatment for recently extubated pt with marked stridor -
\anytime the word "marked" is used think emergency
intubate the pt with 100% FiO2
what is the cause of unilateral wheezing -
\obstruction (usually pedi)
rigid bronch to remove object
when do you use an nasopharygeal airway vs an oropharygeal? -
\naso- conscious pt, do not rotate
oro- unconscious pt- insert upside down then rotate
how do you assess for adequate ventilation post intubation? -
\bilat. chest wall mvmt
auscultate LS
etco2 or capnography
abg/pulse ox. and last cxr for tube placement confirmation
pt in acute wheezing while on the vent; abg is drawn-all gases are normal except pao2
is low; what must you do first? -
\give bronchodilator
mallampatti classification scores -
\scores of 3-4 are bad, low visualization of the airway; pt may need video assisted
device
if pt is unconscious, and outside the hospital environment, VAD will not be available to
intubate*
